Zoe Koz - 10.8 oz (305 g)

Zoe Koz - 10.8 ounces (305 g) - January 6, 2004

Zoe, born at Edward Hospital in western suburb of Chicago, Naperville, IL weighed just 10.8 ounces (305 grammes) and measured only 9 and a half inches long, she was one of the tiniest babies ever to survive.

Picture: Premature New born Zoe 305g (10.8oz)

At birth she was so small she fitted in the palm of her doctor's hand. But the tiny newborn was strong enough to surprise the physicians who delivered her by Caesarean section.

"When I delivered her, she kicked me,'' said Dr. Julie Jensen, the obstetrician who presided over Zoe's birth. "She's feisty.''

Her parents, Tammy and Eric, suspected that having children would be difficult. Tammy, 25, suffers from lupus, an auto-immune disorder that can complicate pregnancies.

Doctors believe Tammy's lupus impaired the development of her placenta, which reduced the flow of blood to Zoe and slowed her growth. Her parents learned of the problem when Tammy underwent an ultrasound test at 20 weeks. Doctors said the baby wasn't growing normally.

At 24 weeks, just before Christmas, doctors gave the couple an agonizing choice: Deliver the child immediately, even though her odds of surviving were virtually nil, or gamble that she could survive in the womb for a few more desperately needed weeks.

Tammy and Eric decided to wait and hope that Zoe would survive long enough for her organs to mature to give her a better chance of surviving. They gained a precious 20 days before doctors concluded Zoe had to be delivered or die. "It was torture, it was the worst three weeks of my life,'' Tammy said.

Doctors estimated Zoe would weigh at least 13 ounces when she was born. Her parents, knowing every ounce could make a difference, hoped the estimates might be low by an ounce or two.

Eric and Tammy were stunned when doctors in the delivery room announced Zoe's weight at less than 11 ounces (< 310g).

26 year old Eric said, "I just about collapsed,'' adding he ended up being ushered out of the delivery room in a wheelchair because he was so upset. "I was in the recovery room before her.''

Zoe was so small when she was born that even the medical equipment used to treat other premature infants was sometimes too big. Her first diapers "came up to her chest,'' Eric said, adding that when he slipped his wedding band on her arm, it slid to her shoulder.

Due to her extremely small size, she needed continuous monitoring and care, including many transfusions. Zoe's grandmother, Ellen Maniowski, age 52, found that her blood would be compatible with her new grandchild and without hesitation volunteered to donate.

Update: Zoe at 3 Weeks old

Mother Tammy holds 3 week old Zoe for the first time

"Babies who are born under a pound and survive are very rare and Zoe seems to have the right stuff at this moment." said Dr. Bob Covert, dir. neonatal intensive care unit.

Tammy and husband Eric are counting their tiny blessing. "I want to make sure everyone knows that ... it's, it's ... babies under a pound can survive. It can happen," said Eric Koz, Zoe's dad.

Because of Zoe's condition her mother, Tammy, has held her just one heavenly time. "She was three weeks old before I was able to hold her ... and I had no idea when I was going to be able to.

But one day I just asked thinking maybe it would be a month or so before I'm going to be able to hold her. So it was just a shock I was able to," said Tammy Koz, Zoe's mother.

Doctors slid Zoe under Tammy's shirt and allowed her to lie on her mother's chest. Physicians believe early skin-to-skin contact with their mother benefits a premature baby, psychologically and physically, Dr. Bob Covert said. "It's pretty much indescribable for any mother to hold her child for the first time," Tammy Koz said, recalling the moment. Emotion prevented her from finishing the thought.

Update February 5, 2004:Zoe is 1 Month old

Zoe is progressing. She receives milk dripped through a tube into her stomach. The amount of milk she can digest has grown more than tenfold as her digestive system develops. Although she uses a respirator, it's to assist her breathing so she doesn't wear herself out.

Picture: One month old Zoe now 17 ounces

The little girl still has big challenges ahead of her, although she's been making good progress since her birth. Now a month old, her weight has climbed to 17 ounces, and at times she has breathed without the help of a respirator. It's not clear when Zoe might be able to go home. It likely will be many months before she's large enough to leave the hospital and doctors are juggling a host of problems, including breathing difficulties, that still threaten her health.

Dr. Edward Bell, a neonatologist at the University of Iowa, said the tiniest preemies typically are hospitalized for three to eight months.

"We don't really know her long-term outcome, babies who are born under a pound and surviving are very rare, but Zoe seems to have the right stuff.'' said Dr. Bob Covert, a neonatologist treating Zoe, who was born three months premature. "We haven't tested things like vision yet. Some things about Zoe's outcome we're just not going to know for some time. As the third-smallest baby in U.S. history, we're treading on untrodden ground."

Her parents are trying to remain optimistic that their first-born child -- whose odds of surviving birth were estimated at only 20 percent to 30 percent -- will overcome the obstacles she faces.

Picture: One month old Zoe now 17 ounces

She's already showing flashes of a strong, prickly personality, her dad said proudly. "She doesn't like being moved around; she fusses,'' Eric said of his daughter, whose name is a Greek word meaning ' Life '. "She's a fighter; she's been a fighter since Day 1,'' he said, "I feel confident Zoe will go home. If her progress continues, she may leave Edward by her original due date of April 5.''

Despite her progress, Zoe remains in the infant intensive care unit that the Hospital added just five years ago. Her immune system is underdeveloped, and her skin is so fragile it must be coated with protectant so that it does not crack and expose her to possible infection.

Update June 10, 2004:5 Months old Zoe goes home

After gaining 86 ounces (5.4lb) and growing eight inches during her 156 days stay at Edward Hospital, little Zoe Koz -- one of the tiniest babies ever to survive -- finally went home from the hospital.

Zoe now weighs 6 pounds and an ounce. She was the third smallest baby ever to be born in the US, and the world's 9th smallest. Zoe still needs oxygen and doctors said that they plan to monitor her development carefully as it was unusual for such a tiny baby to make it. "There were days that I never thought this day would come," Tammy Koz said. "It feels like I had her a couple of days ago and now I get to take her home, but she looks like a normal baby now. But she's 5 months old and it's been a really long road."

She is still on oxygen, but that is expected to last only a few months. She is also eating formula, now that she is 10 times her birth size. Zoe recently had surgery on her underdeveloped eyes. Doctors said they will closely monitor Zoe over the next few years.

It's too early to say whether Zoe will suffer serious medical problems later in life. Cerebral palsy and mental retardation are possibilities, but so is a relatively normal childhood, said Dr. Edward Bell, professor of pediatrics at the University of Iowa and director of neonatology at the university's medical center in Iowa City.

It is wrong to assume that a premature baby will suffer serious physical or mental disabilities, Bell said. "She is probably going to have to wear glasses. There's a good chance she will be the smallest kid in her class picture," Bell said. But that might be it.

Update December 20, 2008:Zoe is nearly 5 Years old

Picture: Zoe soon to be a five years old

It's been almost five years since Zoe entered the world at Naperville's Edward Hospital as the third-smallest baby ever born in the U.S. to survive - she weighed just 10.8 ounces and was only 9.5 inches long. She was born Jan. 6, 2004, three months and three days before she was supposed to arrive.

Zoe Koz may not be your average size, soon to be 5 year old, but she acts exactly like one. Chatty, inquisitive and seemingly growing more independent by the day, Zoe is pretty normal. And that's the best diagnosis her parents could have ever hoped for.

"I really didn't have any expectations after she was born, so everything has surprised me because I really didn't know what to expect," Tammy Koz said. "Every little milestone with her I made a big deal out of because she's my miracle."

She's about the height of the average 2 year old and she weighs what an average 2 year old does. Her parents say the little girl's favorite playthings are often smaller toys, perhaps to make her feel bigger. She even walks on her tiptoes, which give her an extra inch or two in height.

Zoe to become a big sister:

Zoe is one of five children Tammy Koz looks after on weekdays at her home-based day care, but her mom thinks of her as kind of an assistant. "She's a little mommy," Tammy Koz says.

The experience with little ones is going to come in handy now. Zoe is about to become a big sister. The Koz's were scheduled to welcome their second daughter Tuesday. The baby girl also was going to be premature, but this time it was on purpose and by only a few days.

"We knew why Zoe wouldn't grow, so it wasn't a shot in the dark this time," says Tammy Koz's obstetrician Dr. Julie Jensen. Doctors upped Tammy Koz's anticoagulants and her doctor visits have been triple the normal expectant mother's. "She's to the point where we see her once a week," Jensen says. "She's getting followed pretty darn closely."

With all the drama surrounding Zoe's birth, this pregnancy was remarkably unremarkable. "There wasn't one complication with this pregnancy," Tammy Koz insists.

Now, almost five years old, Zoe is welcoming her new baby sister, Faith Koz, into the world. Here, Zoe holds Faith as she looks up at her mom Tammy at Edward Hospital Wednesday.

The couple was planning to adopt earlier this year after Tammy Koz suffered a miscarriage. "We had met with an attorney and scheduled a meeting with an adoption agency and we showed up and nobody from the adoption agency was there," Tammy Kos says. "They never called us. They had completely forgot about us.

Then oddly enough, three days later I took a pregnancy test and I was pregnant." The couple says this is likely their last child. "We wanted Zoe to have a brother or sister," Tammy said "I think we're extremely blessed to have what we have."

Small babies - Low Birth Weight (LBW) or (SGA)

At full term, the average baby will be about 20 inches (51 cm) long and will weigh approximately 6 to 9 pounds (2700 to 4000 grams).

Small for gestational age (SGA) babies are those whose birth weight lies below the 10th percentile for that gestational age. Low birth weight (LBW), is sometimes used to define a baby that weighs less than 5 lb 8 oz (2500 g) regardless of gestational age. One third of babies born with a low birth weight are also small for gestational age.

Other definitions include Very Low Birth Weight (VLBW) which is less than 3 lb 5 oz (1500 g), and Extremely Low Birth Weight (ELBW) which is less than 2 lb 3 oz (1000 g).

About 10 percent of fetuses are low birth weight. A health care provider may suspect fetal growth restriction if the mother's uterus measurement (fundal height) is lower than expected. This can be confirmed with a series of ultrasounds that will monitor how quickly the fetus is growing.

The main causes for Low Birth Weight:The two main causes of LBW are early delivery, also known as preterm birth, and poor fetal growth. About 70% of all LBW babies are born preterm - before 37 completed weeks of pregnancy. The remaining 30% of low birth weight babies are born at full term, but did not grow properly in the womb.More Information on...